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Affordable Care Act Health Care Reform [part 1] AIHFS Dr.

Paul Ryan uncovers another inconvenient truth in health care bill

July 16, 2009 House Ways and Means Committee markup of H.R. 3200

Congressman Paul Ryan presses the authors of the one-trillion-plus dollar, one-thousand-plus page health care bill on another disturbing consequence that hits close to home. In less than five years, a Milwaukee-based employer will no longer be allowed to create new insurance policies in the individual market. The creation of new individual private health insurance plans will be illegal as this bill is currently written.

From H.R. 3200, Title 1, Section 102: LIMITATION ON NEW ENROLLMENT Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of [2013]. (Source: http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf)

Earlier today, Paul Ryan asked House Ways and Means Health Subcommittee Staff Director Cybele Bjorklund to clarify this concern:

Ryan: In 2013, let's take Assurant, a large employer in Milwaukee - 800 of which live in the district I represent - Assurant is a big, individual market insurer. After 2013, Assurant can no longer enroll people in their individual market plans. Is that correct?

Bjorklund: Yeah. They can enroll family members of people who are already in and they can choose to participate in the [federal government] exchange, where they will have a large ready market, many of whom will have subsidies behind their backs, and they can operate in there.

Ryan: Okay. Just to ask the question again: outside of the exchange, which is where they are right now, they can no longer enroll people in the individual market plans they have after 2013 if they want to continue the insurance they have outside of the exchange.

Bjorklund: They can continue to enroll people in the policies that they have operating. They cannot create new policies outside of that window, outside of the exchange, but they can choose to operate in the exchange.

Ryan: I guess I'm gaveled. I had more, but I'll ask you later.

--

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Internal Medicine Health Care Reform Provisions

http://medaccessforamerica.com The Patient Protection and Affordable Care Act (health care reform) has many provisions in it that directly affect the field of internal medicine. Provisions include: covering children until age 26, elimination of preexisting condition exclusions, freedom not to participate in health insurance, adult health quality measures, elimination of co-pay, incentive for prevention of chronic diseases, immunizations, primary care training enhancement, primary care extension program, and extending primary care.

A group health plan and a health insurance issuer offering group or individual coverage shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

No individual, company, business, nonprofit entity, shall be required to participate in any health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.

The Secretary shall identify and publish a recommended core set of adult health quality measures for Medicaid eligible adults in the same manner as the Secretary identifies and publishes a core set of child health quality measures under section 1139, including with respect to identifying and publishing existing adult health quality measures that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time, that may be applicable to Medicaid eligible adults.

Elimination of coinsurance (co-pay) on preventive services (ie. physical exams) in outpatient hospital settings.

Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.

Funds received under a grant under this section shall be used to implement evidence-based interventions including - providing immunization reminders or recalls for target populations of patients; reducing out-of-pocket costs for families for vaccines and their administration; providing for home visits that promote immunizations through education, assessments of need, referrals; or immunization information systems to allow all States to have electronic databases for immunization records.

The Secretary may make grants to, or enter, into contracts with, an accredited public or nonprofit private hospital, school of medicine or school of osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract - to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program in the field of family medicine, general internal medicine, or general pediatrics, for medical students, interns, residents, or participating physicians as defined by the Secretary.

The primary care extension program shall provide support and assistance to primary care providers to educate providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services (including substance abuse and treatment services), and evidence-based and evidence-informed therapies and techniques, in order to enable providers to incorporate such matters into their practice and to improve community health by working with community-based health connectors.

Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.

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